CMS updates payment instructions for new biofeedback CPT codes

On January 28, CMS published a revised Medicare Claims Processing Transmittal 4501 and the associated MLN Matters 11501 regarding the 2020 update to the therapy code list to change a statement about how two new biofeedback codes will be paid. The original update stated that outpatient hospitals would be reimbursed for these codes under the OPPS, but the CPT codes for biofeedback training will actually be paid under the Medicare Physician Fee Schedule (MPFS).

In its 2020 update to the CPT code set, CMS introduced the following new biofeedback codes to replace code 90911 (previously used to report biofeedback training of the perineal muscles, anorectal, or urethral sphincter, including electromyography [EMG] and/or manometry):

• 90912, biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient
• Add-on code 90913, … each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient  

As noted in CMS’ 2020 therapy code list, these new codes are “sometimes therapy codes,” meaning physicians, nurse practitioners, physician assistants, and certified nurse specialists can furnish these services outside a therapy plan of care.

MLN Matters 11501 provides guidance to affected healthcare professionals regarding the appropriate reporting and billing for the new biofeedback codes and other new or updated CPT therapy codes.

Additional information on 2020 updates to CPT codes for therapy services is available on CMS’ website. 

Affected providers can also review guidance regarding appropriate billing for the new biofeedback codes  on their MAC’s website.